An elderly man is observed to fluctuate in his level of cognition, respond to unseen stimuli and cannot turn in the bed properly. Which of the following is the most likely diagnosis?
Exam Question Feb 2008
Lewy Body dementia would explain all three findings. A diagnosis of delirium would not account for the difficulty moving.
Exam Question Feb 2008
Lewy Body dementia would explain all three findings. A diagnosis of delirium would not account for the difficulty moving.
Dementia (types and clinical characteristics)
Dementia is a progressive impairment of cognitive functions occurring in clear consciousness (the clear consciousness aspect differentiates it from delirium).
There are over 100 different causes of dementia. A detailed knowledge is required for the more common types.
Alzheimer's
- Late onset
- Progressive cognitive impairment
- Gradual onset
Vascular dementia
- Sudden onset (not always the case), often following a stroke
- Stepwise progression (not always the case)
Lewy body dementia
(note: Lewy body dementias include dementia with Lewy bodies (DLB) and Parkinsons disease with dementia (PDD)).
- Fluctuating cognitive impairment
- Hallucinations
- Neuroleptic sensitivity (sensitivity to the side effects of antipsychotics such as sedation and EPSE's)
- Falls
- Rigidity, stiffness and movement difficulties
Picks's disease (aka fronto temporal dementia)
- Gradual onset
- Frontal lobe symptoms such as disinhibition, decline in personal hygiene, and personality change
- Speech and language dysfunction including poverty of speech and echolalia
- Focal gyral atrophy with a knife-blade appearance is characteristic of Pick's disease.
Huntington's disease
- Early onset 35-44
- Associated with abnormal movements (chorea)
- Autosomal dominant
Pseudodementia
- Cognitive problems result from depression
- Often reply 'don't know' to questions (compared to people with true dementia who tend to attempt an answer but give incorrect responses)
Progressive supranuclear palsy
- Shares many features of Parkinson's disease apart from tremor
- Presents with loss of balance and falls
- Those affected have problems with voluntary eye movements
